Mental Health and Pop Culture Series

Game of Thrones Part 4 of 5

When I first thought about writing this series, one of the characters that drew me in was Joffrey; that said, since there has been so much written about him, I almost wasn’t going to do it. I thought to myself, “what do I have to say about him that hasn’t already been said?” In truth, I’m not sure that I have anything really new to add to the discussion; however, I also feel as though it would be an injustice to the series not to write about him because his apparent mental health issues are so prominent to his character. Also, while Joffrey has been one of the most talked- about characters due to his readily apparent mental health issues, I have not seen much in the way of treatment options offered.

Joffrey Baratheon is the son of Cersei Lannister and her brother Jamie, though he is brought up as the son and heir of King Robert Baratheon; he is the older brother to Myrcella and Tommen. Joffrey comes across perhaps more one-dimensional then many of the other characters in Game of Thrones; in fact, I once read that anyone who watched the show could identify him as a sociopath from the very first episode.

When we are first introduced to Joffrey, he comes off as being self-centered and arrogant; but, he also briefly shows the capacity for caring. He shows no interest in meeting any members of the Stark family, though after he is betrothed to Sansa Stark (eldest daughter to Ned and Catelyn), he quickly appears to show her interest and talk of their future together. At the same time, he mistreats everyone else around him, including his bodyguard, his uncle Tyrion, members of the Stark household, and so on. He appears to disdain his father, King Robert, but put up with him. He appears closest with his mother, Cersei, and complains to her about Sansa, his situation, and so on.

Self-centeredness and arrogance, however, are the least of Joffrey’s mental health issues. The first true example of his most serious issue, antisocial personality disorder, comes to the fore when he basically orders the execution of the butcher’s son who was sparring with Arya (Sansa’s tomboyish younger sister), and accidentally hits Joffrey. This, despite protestations from Arya that it was her fault and that it was an accident. Further, Joffrey was responsible for the execution of Lady, Sansa’s pet direwolf because a direwolf bit him (Arya’s direwolf, Nymeria).

Antisocial personality disorder is the clinical term for sociopathy. However, strictly speaking, Joffrey only shows symptoms of the disorder, as antisocial personality disorder cannot be diagnosed until someone is at least 18 years old; however, at the time of his death, 19, he could certainly have had the diagnosis. Joffrey’s symptoms include: failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, recklessness toward safety, irresponsibility, and a lack of remorse - in fact, Joffrey delights in torture and murder. Despite playing tough, Joffrey is also, perhaps, one of the biggest cowards in the entire series.

After King Robert’s death, Joffrey becomes king (despite King Robert’s express wishes), and he trumps up charges against Ned Stark. Ultimately, Joffrey has Ned executed, despite protestations from his mother who thought she could control him. Joffrey takes every opportunity possible to torture and humiliate Sansa. When Joffrey’s uncle, Tyrion, attempts to provide an outlet (women) for Joffrey to release his “tension,” Joffrey ends up abusing the women, and eventually kills one of them. Joffrey thinks of himself as the hero and is blind to see that no one in his kingdom actually wants to follow him; additionally, he apparently has no problem killing anyone who doesn’t agree with him - to the extent that he warns his mother that if she touches him, he will kill her (this, despite the fact that his mother is, perhaps, the only person in all of Westeros who supports him).

How do you treat someone with such issues? In a general sense, treating someone with antisocial personality disorder can be done as an outpatient, and treatment through cognitive behavioral therapy can be effective. The key in such a case would be to focus on educating the client about the disorder, and especially the consequences. In more severe cases, a client would need to be treated with medication in addition to psychotherapy, though there is no specific medication protocol at this time. In still more extreme cases, the client would need to be treated on an inpatient basis. The important aspect to treatment here is helping the client to see and understand the consequences.

But, what about Joffrey, for whom there are apparently no consequences, since he’s at the top of the chain? Since a sociopath is harmful to himself as well as others, the first important thing to do would be to isolate Joffrey so that he could not be in a position to actually harm anyone else. We see his uncle Tyrion and his grandfather Tywin attempt to do this by not including Joffrey in any real decision-making. But, that wasn’t really enough, as evidenced by Joffrey’s behavior. Joffrey comes across as such an extreme sociopath, he really needs to be locked away in the dungeons and treated with antipsychotic medications to reduce his aggression and manage his impulse control. Potentially, the medication could help him to overcome a mood disorder which would allow therapy to be more effective. Of course, as a social worker, I cannot provide psychopharmacology, but I would bring in a psychiatrist to assist in that regard. Once Joffrey’s mood is effectively stabilized, I would be able to utilize CBT techniques with him as well as talk-therapy techniques.

Despite Joffrey’s disorder, he exhibits signs of religious behavior, including his initial reluctance to break of his engagement to Sansa in favor of marrying Margaery Tyrell because he viewed the betrothal to be a sacred vow. Therefore, I might attempt to use his religious proclivities in therapy and remind him that while he believes himself to be king due to certain divine rights, that does not make him infallible or invincible. While I wouldn’t want to give up on a client like Joffrey, I would also refer him to a specialist in antisocial personality disorder if I didn’t see myself making any real progress. Sometimes knowing when to refer a client to someone with a speciality is the best thing that you can do for a client.